Sunday evening, 60 Minutes correspondent Bill Whitaker went to Columbus, Ohio, to understand America's heroin epidemic. The drug is becoming cheaper and easier to get, he argues, and its stigma is vanishing. But his reporting places much of the blame for the addictions and deaths he documents on opioid pain pills. People become addicted to the pills, and than switch to heroin because it is cheaper.

“I graduated in the 80s,” Tracy Morrison, a nurse, tells the newsmagazine. “I was a nursing director when we decided to swing the pendulum from not treating pain to treat everybody's pain. I was a part of that. And at that time, I had no idea that we were addicting people.”

Now Tracy has two daughters who are both addicts. One of them, Jenna, talks to 60 Minutes, saying she started on pain pills at 15 or 16 and progressed to heroin when she was 18. Eventually, she overdosed and almost died. But Whitaker finds more damning anecdotes. He talks to parents whose teenage children became addicted to opiates that were originally prescribed to them by their doctors. Tyler Campbell, for instance, was a high school football star. His parents said he became addicted to opiates after his doctor prescribed him 60 Vicodin for a shoulder surgery. (Vicodin and generic versions of it were, incidentally, the most prescribed medicine in the U.S. every year between 2009 and 2012.)

Some people are obviously becoming addicted to drugs like Oxycontin and Vicodin because they abuse them, without ever needing to take them for pain. And some are starting heroin because it is cheap, because the stigma that it once had is decreasing, and because it can be smoked or snorted, instead of injected, making it easier to use it at a party. And we should always be suspicious of the narrative 60 Minutes adopts here, that a drug that was once used by “other people” is now being used by “people like us,” or, as one of 60 Minutes’ telegenic subjects puts it, “even Miss America could be a junkie.”

And some people do need these drugs because of pain. “What about those POOR SOULS who need Pain KILLERS, but now cannot get them,” writes commenter CESNNEWYORK on CBS’ site. “I have had to SUFFER with [a] knee that needs to be replaced, but because DOCTORS are not ready issue these meds I have to SUFFER.”

The flip side of this pain and suffering is that prescription pain pills cause 16,000 deaths a year in the U.S., not counting those caused by heroin. How to we balance the benefit of these drugs against that clear risk? A terrifying letter published in The New England Journal of Medicine last week showed that even as the abuse of pain drugs like Oxycontin, Percocet, and Vicodin seems to have dropped off, it has been replaced by the use of heroin. Do we view that as the overuse (and marketing) of opioid pills causing heroin use, or as restrictions on needed drugs causing an increase in heroin use? Is it both?

Andrew Kolodny, the chief medical officer of addiction treatment facility Phoenix House, argued to me over email that those who switch to heroin may be better off than those who don’t. He says that older people who become addicted to painkillers have less trouble getting pills from doctors than teenagers, and that they are more likely to overdose than those who switch to heroin.

As I reported earlier this year, it’s going to be difficult to put the opioid genie back in the bottle. For instance, abuse-resistant forms of the drugs introduced by companies like Purdue Pharma, Oxycontin’s maker, may have only a minimal impact. But the controversies over drug pricing that have hit the pharmaceutical industry make me wonder why some obvious solutions haven’t been tried.

Take, for instance, specialty pharmacies, mail-order facilities that can both make sure patients get their medicines (think refills) and that manufacturers known where the medicines go. These came into use for drugs for rare conditions that were dangerous. Things like thalidomide, for blood cancer, which causes birth defects and Xyrem, for narcolepsy, which can be abused or used as a date-rape drug. Medicines that would otherwise be too dangerous to market could help patients.

Using these specialty pharmacies for opioids, the most popular drugs at the pharmacy, would be a terrible inconvenience to pain patients, points out David Juurlink of Sunnybrook Health Sciences Centre in Toronto, a critic of opioid overuse. "I suspect this question would not have occurred to you in 1996," he says. "It's arising now because of all the harm that's been done."

But in the past month we've seen that these specialty pharmacies sometimes seem to be used solely to make sure insurance companies pay for expensive drugs. Turing Pharmaceuticals used a specialty pharmacy when it increased the price of an old toxoplasmosis drug, Daraprim, by 5,000%.
Valeant Pharmaceuticals is being scrutinized by its investors because of its relationship with a specialty pharmacy it used to sell Jublia, a drug to treat toenail fungus. If these kinds of distribution systems can be used to make sure patients get their pricey toenail fungus treatment, why can't they be used to control the distribution of pain medicines?

It's time to grope for solutions -- and to really search for answers. We need better data on how people become addicted to these drugs, and better ways to stop those addictions from ever happening.